Parenteral Nutrition - 6 Flashcards Preview

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Flashcards in Parenteral Nutrition - 6 Deck (11):
1

What is it?

•Parenteral Nutrition (TPN, PN) - Administration of nutrients via a route other than GI system

•Enteral – nutrition via GI(eg. G, NG tubes, oral)

•Other fluids not sufficient to meet nutritional needs

•Average adult needs a minimum of 1200-1500 calories per day

2

What’s in it?

•Base solution of dextrose and amino acids – hyperal or hyperalimentation fluid
•Pharmacy adds electrolytes, vitamins, and trace elements per patient needs
•Very hypertonic (draw fluid into intravascular space)
•Typically a yellowish tinge, 2,000-3,000mls
•Lipids – given with TPN, over 12 hours, white color, smaller volume, pt. at risk for fat embolism

--distal lumen

3

What's in it? Cont.

•Lipids may have egg yolk present, check for allergies
•Hyperal may contain:
-insulin – control blood sugar levels
-and/or heparin – usually only in neonates, helps keep central line patent for longer and prevents infection in central line – prevents bacteria from adhering to surfaces

4

Your pt is receiving TPN for treatment of malnutrition. Which value would be the most helpful in evaluating the effectiveness of this treatment?
 A – Blood glucose level
 B – Serum albumin level
 C – Serum phosphate level
 D –Hemoglobin and Hematocrit

B

protein turns into albumin - levels stay pretty consistant

phosphate levels indicate refeeding syndrome

5

Nursing Care

•Special IV tubing (run through different channels)
•Needs a filter – prevent air, particulate matter from infusing
-60 micron - hyperal - always use - line will have y-site
-10 micron - lipids - depends on lipid manufacturer for use - no y-site on line
•Almost always given via a central line, PICC, etc
•Can be given peripherally, monitor for phlebitis
•Lipids – Good for 12 hours
•Hyperalimentation (Hyperal) - Good for 24 hours

6

Nursing Care

•Keep refrigerated until use
•Don’t add anything to TPN
-- also nothing through y-site
-- can flush with NS
•Change IV dressing per orders (PICC, CL, PIV) and monitor site
•Educate pt and family on PN
•TPN/Lipids/Hyperal expire – assess bag and content for separation, expiry dates, sediment, etc
•Give TPN and Lipids *AS THEY ARE ORDERED*
-ex. – new bag ordered to be hung while old bag is still running

7

Cycling

•Typically given over a 24 hour period but may be less, e.g. 12 hour cycle

•Cycle usually starts at night because patients at home on TPN start at night for quality of life

8

Scaling up/down

•TPN often started at a lower rate and increased gradually to desired rate/amount
•Same for stopping
•Helps prevent hypo/hyperglycemia and refeeding syndrome when at risk
•Not always necessary but generally better outcomes

9

Most common complications

•Hypo/hyperglycemia
•Phlebitis, other IV catheter complications
•Electrolyte imbalances/fluid imbalances (overload & deficit both)
- TPN is not fluid replacement, TPN is "food"
- also needs to be on a fluid

10

Refeeding syndrome

•Complication which occurs in the severely malnourished or starved once nutritional support is provided
•Alcoholism, vomiting, diarrhea, chemotherapy can all predispose a pt
•Characterized by fluid retention and electrolyte imbalances
 *HALLMARK SIGN IS HYPOPHOSPHATEMIA*
 Muscle weakness, mental status change, <2.4 mg/dl

cells deplete nutrients in attempt to digest nutrients

phosphate, calcium, macronutrients

11

Assessment

•Weight, Is&Os, general nutrition
•Serum electrolyte levels (phosphate)
•*Blood glucose levels for all PN pts.* Q6
 Why do you think that is? (insulin fluctuates throughout day, intake levels do not)
•Albumin levels (prealbumin)
 Why do you think that is? (tissue growth and repair; protein synthesis)
•Why is the patient getting this?
 Nutrition obviously, tissue healing, supplementary nutrition, total nutrition?